American College Of Sports Medicine Updated Energy Drink Guidelines
The American College of Sports Medicine (ACSM), the largest sports medicine and exercise science organization in the world, released updated guidelines on energy drinks in February 2018. Worldwide, the global energy drink market was worth $39 billion in 2013 and is forecast to reach $61 billion by 2021.1
What are energy drinks?
Energy drinks are beverages that contain caffeine and often vitamins, minerals, amino acids, herbal mixtures, and sweeteners. While other beverages may contain some of these ingredients, energy drinks typically contain high concentrations of herbal blends, vitamins and some amino acids.1 Energy drinks are promoted to increase alertness and enhance physical and mental performance, although there is very limited scientific data to back up these claims.2
The first energy drink introduced in the United States was Jolt Cola, first available in 1980.3 Energy drinks include brands such as Red Bull, Monster Energy, and Rock Star.4
Concerns with energy drinks
Together the U.S. Poison Control Center and the Food and Drug Administration’s (FDA) Center for Food Safety and Applied Nutrition Adverse Event Reporting System reported more than 700 adverse events, including 19 deaths, involving energy drinks between 2000 and 2012. Almost 50% of the adverse events reported were in children younger than 6 years. The FDA’s reporting system is estimated to capture only approximately 1% of the true adverse events associated with energy drinks, making the number of adverse events and deaths likely to be much higher.1 Although most healthy adults can consume an occasional energy drink without any significant negative effects, the long-term effects of drinking more than one energy drink every day, for weeks or months, have not been well studied.1,2
Adverse events associated with energy drinks include trouble sleeping, anxiety, increased blood pressure, increased heart rate, seizures, and even death. Especially vulnerable populations include children and teens, pregnant or breastfeeding women; and people sensitive to caffeine, who use stimulant or caffeine-based medications, with certain cardiovascular or medical conditions, or who drink 2 or more energy drinks in one session.1 Combining energy drinks with alcohol can lead to greater intoxication and increased risk of adverse events.2
Caffeine content of energy drinks is not limited by the FDA while caffeine in other beverages cannot exceed 20 mg per 100 mL. 400 mg of caffeine per day, the amount in 4-5 cups of coffee, is the amount of caffeine not generally associated with dangerous effects for healthy adults. Caffeine levels in energy drinks vary widely, ranging between 30-134 mg of caffeine per 100 mL. Guarana and yerba mate are natural sources of caffeine that are often added to energy drinks, yet the caffeine in these sources is typically not part of the package labeling.1
The multiple ingredients in energy drinks, often in combination with heavy consumption patterns, appear to be more problematic than coffee or caffeine alone. Some of the herbals commonly found in energy drinks have been associated with minor to severe adverse effects including seizures, stomach upset, heart attack, and heart rhythm disorders.1
A special concern for children
Children experience far more adverse events from energy drinks than adults because of the higher total body concentrations of caffeine relative to their body size, and they haven’t built up a tolerance to caffeine. Because of the greater risk in children, the American Academy of Pediatrics and the National Federation of State High School Associations recommend that children or adolescents should never consume energy drinks, and that energy drinks should never be used for hydration before, during or after physical activity.1 Even the American Beverage Association, the trade association that represents companies that manufacture and distribute non-alcoholic beverages, including energy drinks, recommends restrictions including marketing energy drinks separately from sports drinks to avoid confusion and not selling or marketing energy drinks in schools.5
ACSM’s primary recommendations focus on four key areas1:
- Protecting children at risk. Children and adolescents are at particularly high risk of complications from energy drinks due to their small body size, not being used to drinking beverages with caffeine, and potentially heavy and frequent consumption patterns. The message that these beverages are not intended for children needs to be re-enforced and widely disseminated.
- Stop marketing to at-risk groups, especially children. Marketing should not appeal to vulnerable populations, and target marketing to sporting and other events involving children and adolescents should not be permitted.
- Regardless of health and fitness level, and until such time that proper safety and efficacy data are available, energy drinks should be avoided before, during or after strenuous activities.
- More education and data are needed, and investment in awareness and educational resources highlighting the potential adverse effects and safe use of energy drinks is required. Significant efforts should be made to educate consumers regarding the clear differences between soda, coffee, sports drinks and energy drinks. Energy drink education also should be a priority in school-based curricula related to nutrition, health, and wellness.
Other specific recommendations include1:
- Energy drinks should never be mixed with alcohol.
- Energy drinks should contain a warning on the label such as “High Source of Caffeine”
What does this mean for parents?
Because leading health and fitness organizations strongly recommend children and teens should avoid energy drinks, it’s important that parents communicate the potential dangers of energy drinks to their children and also set a positive example by avoiding energy drinks themselves. Make sure that your children are choosing plain water as their primary beverage.
1. Higgins JP, Babu K, Deuster P, Shearer J. Energy Drinks: A Contemporary Issues Paper. Curr Sports Med Rep. 2018 Feb;17(2):65-72. doi: 10.1249/JSR.0000000000000454.
2. U.S. Department of Health and Human Services. National Institutes of Health. National Center for Complementary and Integrative Health. Energy Drinks. https://nccih.nih.gov/health/energy-drinks last updated 10-4-17. Accessed 4-22-18
3. eXtension. Energy Drinks History. http://articles.extension.org/pages/20867/energy-drinks:-history Posted 2-28-09, accessed 4-22-18
4. Statista: The Statistics Porta. Leading energy drink brands in the United States in 2017, based on sales. https://www.statista.com/statistics/235185/leading-20-energy-drink-brands-in-the-united-states-based-on-sales/ Accessed 4-25-18
5. American Beverage Association. ABA Guidance for the Responsible Labeling and Marketing of Energy Drinks. https://www.ameribev.org/files/resources/2014-energy-drinks-guidance-approved-by-bod-43020c.pdf Adopted 4-30-2014, accessed 4-22-18.